| Print and complete the following form and send or fax to your Credit Union. | |||
| Torrance Office | Anna Office | East Liberty Office | Marysville Office |
| P.O. Box 2290 | 12500 Meranda Rd | 11000 S.R. 347 | 19775 S.R. 739 |
| Torrance CA 90509-9874 | Anna, OH 45302 | East Liberty, OH 43319 | Marysville, OH 43040 |
| Fax: (310) 972-7002 | Fax: (937) 498-5618 | Fax: (937) 644-6768 | Fax: (937) 642-5184 |
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1. Member Information |
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_________________________________________ Member Name |
_____________________________________ Social Security Number |
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2. Open New Account(s) |
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| [] Savings [] Secondary Savings [] Honda Cash Funding [] Bill Payment [] Premier Money Market |
[] Checking [] Overdraft from Regular Savings [] Overdraft from VISA Line of Credit [] No Overdraft |
[] Savings Certificate - Term___________ [] Other(Specify)_______________________ [] Other(Specify)_______________________ [] Other(Specify)_______________________ [] Other(Specify)_______________________ |
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3. Add Joint Owner(s) |
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Joint Owner #1 ____________________________________
Name
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______________________ Social Security Number |
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_______________________ Relationship to Member |
(___)_____________ []Work []Home Telephone Number |
______________ Date of Birth |
___________________ Monthly Income |
_____________________ Mothers Maiden Name |
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____________________________ E-mail Address |
Designate on which Account to add this Joint Owner: _______________________
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Joint Owner #2 ____________________________________
Name
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______________________ Social Security Number |
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_______________________ Relationship to Member |
(___)_____________ []Work []Home Telephone Number |
______________ Date of Birth |
___________________ Monthly Income |
_____________________ Mothers Maiden Name |
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____________________________ E-mail Address |
Designate on which Account to add this Joint Owner: _______________________
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4. Pay-On-Death |
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| Pay on Death In the event of Your death You, the undersigned,
a member of the credit union, hereby designate the following beneficiary(ies): Beneficiary(ies) Designation for Pay on Death Account. |
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________________________________ Name |
__________________________ Social security Number |
______________________ Date of Birth |
_______________ Percentage |
________________________________ Name |
__________________________ Social security Number |
______________________ Date of Birth |
_______________ Percentage |
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Consent of Spouse (If beneficiary is other than spouse) |
__________________________________ Signature of Spouse |
____________ Date |
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5. Signatures |
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Member Authorization:
By signing below, You authorize the addition of the Joint Owner(s) indicated in this Account Owner Designation. By
signing below, You also acknowledge receiving a copy of the Agreements and Disclosures and You agree to be
bound by the terms and conditions found therein. If this Account Owner Designation includes the addition
of a Joint Owner, You understand and agree that any such Joint Owner will have access to Your Account and any
Account services shown herein to the same extent that You have access to Your Account and/or Account
service(s) and, unless We receive satisfactory notice to the contrary will have equal rights to Your
Account service(s). Joint Owner(s) Authorization: By signing below, You authorize Honda Federal Credit Union to add You as a Joint Owner on the Account(s) and/or the Account service(s) identified in this Account Owner Designation. By doing so, You acknowledge receiving a copy of the Agreements and Disclosures and You agree to be bound by the terms and conditions found therein. You further understand and agree that the Member and any other Joint Owners on the Account(s) and/or Account service(s) identified herein will have access to the Account(s) and/or Account service(s) on which You are a Joint Owner to the same extent that You have such access and, unless We receive satisfactory notice to the contrary, will have equal rights to those Account(s) or Account service(s). You further understand and agree that You are bound by the terms and conditions of the bylaws, rules and regulations of Honda Federal Credit Union in effect from time to time for all Accounts or Account services for which You are a Joint Owner. Subject to applicable laws and regulations, You further authorize any person , association, firm, corporation, personnel office or credit reporting agency to furnish, upon Our request, information concerning Your employment, credit standing and financial responsibility. In addition to using this information to evaluate your continuing eligibility for Joint Ownership, it may also be used to pre-determine Your possible eligibility for various Honda Federal Credit Union products and services. |
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____________________________________________________________ Primary Owner Signature |
_________________ Date |
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____________________________________________________________ Joint Owner#1 Signature |
_________________ Date |
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____________________________________________________________ Joint Owner#2 Signature |
_________________ Date |
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Credit Union Use Only |
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____________________________________________________________ Share ID(s) |
_______________________ Opened by/Date |
[] o/o | ||